Beneficial effect of combined aspiration and interstitial laser therapy in patients with benign cystic thyroid nodules:: a pilot study

The aim of this study was to evaluate the effect of combined cyst aspiration and ultrasound-guided interstitial laser photocoagulation (ILP) on recurrence rate and the volume of benign cystic thyroid nodules. 10 euthyroid outpatients with a solitary and cytologically benign partially cystic thyroid nodule causing local discomfort were assigned to cyst aspiration followed by ultrasound-guided ILP and followed for 12 months. The ILP was performed under continuous ultrasound-guidance and with an output power of 2.5-3.5 W. The volume of the nodules was assessed by means of ultrasound and determination of the amount of aspirated cyst fluid, thereby calculating the volume of the solid part. Follow-up included ultrasound and determination of thyroid function. Pressure and cosmetic complaints were evaluated on a visual analogue scale. The median initial volume of the cystic nodule decreased from 9.6 ml [6.8;15.5 (quartiles)] to 3.5 ml [2.7;9.0 (quartiles)] (p=0.0001), and the median cyst volume from 3.0 ml [2.0;6.0 (quartiles)] to 0 ml [0;0.5 (quartiles)] (p=0.0001) during follow-up. Recurrence of the cystic part was defined as a cyst volume > 1 ml. In eight of 10 patients there was no recurrence of the cystic part. Both pressure symptoms and cosmetic complaints were significantly reduced. The only side effect was mild pain or tenderness for a few days. Our study suggests that complete cyst aspiration and subsequent ultrasound-guided ILP of benign cystic thyroid nodules is a feasible and safe technique, resulting in a significant reduction in the volume of both the solid and the cystic component. A large-scale prospective randomized study is warranted.